Nathaniel ACT

The Intervention: Assertive community treatment (ACT) as an alternative to incarceration

Who Is Served: Adults with serious mental illness facing incarceration as the result of felony arrest

The Challenge

Jail and prison have become facilities of last resort for many people with serious mental illness, contributing to a cycle of crime, incarceration, release, and recidivism worsened by ineffective treatment and the traumatic conditions of correctional facilities. While the total New York City jail population has decreased in recent years, the rate of individuals with mental illness has steadily grown. In 2015, more than 40% of inmates at Rikers Island had symptoms of mental illness, with approximately 7% diagnosed with serious mental illness.1 Once in the system, those with mental illness tend to cycle again and again through the courtroom, jail, and prison.2 In recent years, media such as the New York Times have described the violent treatment of inmates with mental illness at Rikers Island, where “brutal attacks by correction officers on inmates—particularly those with mental health issues—are common occurrences.”3 These conditions likely contribute to poor outcomes upon return to the community, with people with mental illness returning to jail twice as fast compared to individuals without mental illness who are charged with similar crimes.4

The Nathaniel ACT Approach

In 2000, CASES launched the Nathaniel Project, the city’s first alternative-to-incarceration program for adults with serious mental illness facing incarceration as the result of felony charges including violent arrests. Named for a man whose schizophrenia went untreated as he cycled in and out of jail and prison for 15 years, the Nathaniel Project earned national recognition for safely supervising people with felony histories and serious mental illness in the community and helping them to engage in treatment. This recognition included the American Psychiatric Association’s Significant Achievement Award and the American Probation and Parole Association’s President’s Award.

In 2003, CASES transitioned the program to a State-licensed assertive community treatment (ACT) team. ACT is an evidence-based practice providing intensive, mobile team treatment delivered primarily in clients’ community settings. ACT staff include experts in psychiatry, mental health, nursing, social work, substance abuse treatment, peer support, housing, employment, family, and criminal justice. Nathaniel ACT is structured as a two-year alternative-to-incarceration program, with services available 24 hours a day, seven days a week and including:

Immediate subsistence services to support the transition from jail to the community

Comprehensive clinical assessment and treatment planning

Nursing services including to support management of psychiatric medication

Ongoing advocacy and support with managing requirements related to involvement in the criminal justice system

The wraparound, holistic services provided by Nathaniel ACT ensure clients have the support they need to succeed in treatment, stabilize in the community, and avoid further justice involvement. As noted above, the team delivers services primarily in the community settings where clients live, work, and socialize and where support is needed most.

The Impact

Nathaniel ACT has achieved significant impact on recidivism rates among clients, a population with an average of more than eight lifetime arrests and who at program intake are facing a prison sentence on average of 4.5 years. Program results include:

Among Nathaniel ACT graduates since 2013, none have a new felony conviction in the two years following program completion

No new Nathaniel ACT clients since 2014 have had a violent arrest within one year of program intake

In addition to its criminal justice focus, Nathaniel ACT also supports critical health and wellness outcomes for clients, who achieved the following improvements in 2015:

200% increase in employment

50% increase in education activity

56% decrease in homelessness

63% reduction in harmful behaviors

Referrals

The Nathaniel ACT Program serves individuals indicted on felony charges who are jail- or prison-bound and who have a severe and persistent mental illness. Individuals must have a demonstrated history of noncompliance with traditional mental health treatment services and have high use of acute psychiatric hospitals.